Global health problems need international solidarity and global responses.

1
Third International Jerusalem Conference on
Health Policy Jerusalem December 10.-13.
2006 Health Systems Are we in a Post Reform Area?
Global health problems need international
solidarity and global responses. Keynote
Presentation Hans Stein (Germany)
2
Challenges Health systems have to face

• demographic changes, high life expectancy,
  graying society
• changes in disease patterns, new health threats,
  increasing life-style diseases
• scientific progress, new health technologies,
  e-health
• expansion of health and medical care systems
• growing economic restraints and limited resources
• rapidly growing private health market
• increasing inequalities
• growing expectations of informed citizens

Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
3
Conclusion
Health systems will be under permanent growing
pressure. Health will become a dominant topic
of political and social discussion.
Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
4
A new not yet sufficiently recognized health
development

• The process of Globalization
• It will lead to
• Internationalisation of health risks and greater
  independence of different health systems.
• Threat or opportunity?
• How will health systems be able to cope with
  these challenges?

Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
5
No scarcity of ideas

• health reforms
• improvement of efficiency and effectiveness
• funding options
• financial sustainability
• decentralization
• privatization
• new market mechanism
• improving quality, equity, access
• participation and rights of patients

Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
6
Ideas need

• Implementation
• Political will and commitment  
• Reform
• Have past systems centered reforms met self set
  objectives?
• Have they changed or only stabilized existing
  system?

Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
7
? ? ? Can present health systems survive as
isolated islands in the tide wave of
globalization?
Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
8
Global health goes beyond national boundaries
and governments.

• Globalization
• leads to rapid spread of health problems
• increases scientific and technological
  knowledge
• thru communication removes technical barriers
  and overcomes national borders
• improves and transforms health care
• increases inequality
• makes health a major economic growth factor
  in a global health market
• changes face and content of international
  politics

Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
9
and foremost

• Can health remain as a sole and foremost
  national responsibility?
• Can national health systems give the needed
  global response?
• Can existing independent national health
  systems survive?
• Will they able to be rethink?

Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
10
The present situation of EU Member states

The welfare state especially health policy
actually appears to be an enclave within EU
integration process and consequently one of the
last realms and one of the last retreats of
national policy competence. National
governments have jealously and successfully tried
to prevent any transfer of substantial health
policy to the supra-national level and the still
have great difficulty in accepting health policy
as a matter of the Union concern. Lamping,
(University Hannover 2003)
Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
11
The EU situation

• The constitution
• Health is not mentioned as objective.
• Health is not an area of exclusive or shared
  competence.
• Health is only an area for coordinating,
  complementary of supporting action.
• The Charta of fundamental rights gives the
  rights of access to health care under the
  conditions established by national laws and
  practices.
•  

Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
12
New Focus on ethics and values not only at
national but also at international European
level After a decade of mainly economic
debate health values should drive health
action.
Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
13
Questions

•  
• Are there European or even Global health values?
•  
• Do they affect health policy at national,
  European or even global level?  

Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
14
The EU Health Council June 2006

1.) Values and principles as overarching values
for national health care systems in the
EU - Universality - Access to good quality
care - Equity - Solidarity 2.) They have to
be protected against undue European Interference.
 
Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
15
Needed rethink

• In a globalized world no such place as abroad.
• Problems and solutions reach across national
  borders.
• No distinction between internal national and
  external solutions.

Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
16
Therefore

• Interdependence of global health requires
• Common national, European and global values
• Solidarity
• Political will and commitment
• Public support
• International cooperation, coordination and
  new partnerships
• Going beyond exchanging ideas, sharing
  experiences
• Joint strategies and actions
• Resources
• Instruments

Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
17
New Instruments  

• International laws for Health
• International Health Regulation
• Framework Convention Tobacco Control
• Agencies and Support
• European Centre for Disease Prevention
  Control
• (Surveillance Control of new health threats)
• European Institute/Observatory for Health
• (Evidence base for policy)
• Health Technology Assessment Network
• Centres of Reference Networks
• (High Quality care open to all countries)
• Supporting Programmes for cross border
  services
• (Telemedicine / e-health)

Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
18
Globalized Health Strategies  

• cannot be achieved by individual systems/states
  alone
• need global governance and partnerships
• (e.g.WHO, EU, World Bank, OECD, WTO )

EUROPEAN UNION should

• be a key actor
• make global health a top priority
• establish strategic priorities
• include global health in all its fields of policy
• (Foreign Affairs, Agriculture, Trade,
  Environment)
• create new institutions and programmes

Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)
19
The future of Health Sans Cordon sanitaire  
The future of global public health is a future
not characterized by isolation, but by global
cooperation, global governance and global
partnership.   The benefits if this cooperation
in the future will lead to an overall more
healthy society, characterized by enhanced
economic output and reduced strain on public
health care systems.   The perception of society
will develop into a more cooperative,
integrative, prioritized and proactive view of
public health.   David Byrne (former EU Health
Commissioner)

Third International Jerusalem Conference on
Health Policy Global health problems need
international Jerusalem December 10.-13.
2006 solidarity and global responses. Health
Systems Keynote presentation Are we in a Post
Reform Area? Hans Stein (Germany)